Expert Speak Health Express
Published on Jan 06, 2021
The difference between conventional and alternative medicine must eventually be removed so that the medicines that work are available to all practitioners.
Policy challenges amidst modern medicine and AYUSH: What is the solution?

A recent gazette notification by the Central Council of Indian Medicine (CCIM) specifying a list of 58 surgeries that could legally be carried out by Ayurvedic doctors who had qualified in post-graduation, including MS (Ayurveda), MS (Gynaecology), MS (ENT) and MS (Ophthalmology) has put “allopathic” doctors and associations on the warpath. The Indian Medical Association (IMA) has taken their objection up in a big way, holding public demonstrations against it and calling for a one-day strike. The Maharashtra Medical Council, in its circular dated 15 December 2020, stated that a person obtaining qualification in any other system of medicine is not allowed to practice Modern system of Medicine in any form” and that “the physician should practice methods of healing founded on scientific basis and should not associate professionally with anyone who violates this principle, warning that any such an association would be a breach of ethics. The associations have not been satisfied with a clarification issued by the CCIM that the said gazette notification was for clarity.

The government now has two choices: Keep traditional and modern medicine separate and maintain the purity of each, or integrate them fully and allow physicians to decide the modality they would like to use as treatment.

The abovementioned surgical courses were already in existence since several years. The problems associated with “cross-pathy” are a legitimate cause of concern. A 2018 paper pointed out that “existing state policies that legitimise Allopathic practice by non-Allopathic practitioners do not help the rural poor to access proper medical treatment for acute conditions,” or “enhance the credibility of the indigenous systems of medicine.” However, it is equally true that modern medicine has liberally borrowed from traditional medicines both in pharmacopeia as well as in surgical techniques — the kshar-sutra was incorporated as “seton” and forehead and cheek flaps used by Sushruta for nose reconstruction are still mainstream in modern plastic surgery. Over the centuries, the line between traditional and modern has been significantly blurred. The government now has two choices: Keep traditional and modern medicine separate and maintain the purity of each, or integrate them fully and allow physicians to decide the modality they would like to use as treatment.

Academic rigour

Ayurvedic practitioners’ graduation courses are often substandard and the post-graduate courses offered at most of their institutes are of extremely poor quality. The same rigour seen in MBBS and post-graduate medical colleges is generally lacking. Successive governments have made it easier to set up AYUSH medical colleges. A 2011 paper pointed out that there were “serious flaws” in the BAMS course, due to which a large number of graduates lacked basic clinical skills. Most AYUSH institutions would have to shut down if they were subjected to the same norms of stringency in scrutinisation that MBBS medical colleges are subjected to, and, indeed, have survived despite this chiefly due to political patronage. In 2019, the Central Government granted conditional permission to 352 AYUSH medical colleges. Whereas, MBBS graduates and post-graduates from public hospitals have to mandatorily serve a specified bond period in rural areas, graduates and post-graduates from AYUSH public hospitals are not subjected to any such restrictions. Whereas, accreditation is being virtually made a prerequisite for empanelment with insurers and government schemes for Modern Hospitals, only three AYUSH hospitals in the entire country have been accredited in the past ten years.

Research output

By and large, very few Ayurvedic treatments have been successfully validated by well-designed randomised controlled trials (RCTs). Due to this, the vast potential of the science has not been tapped. A few RCTs have been conducted, such as a trial comparing conventional anti-diabetes treatment with Ayurvedic system that showed equivalent outcomes in control of Diabetes mellitus. RCTs published in the Journal of Clinical Rheumatology compared outcomes of conventional, Ayurvedic and combination therapy in the treatment of rheumatoid arthritis as well as Hydroxychloroquine with standardised Ayurvedic multi-herb therapy which showed that outcomes were equivalent in the Ayurvedic group with fewer adverse effects. On the other hand, another RCT found that there was no difference between outcomes of treatment of diarrhoea-predominant IBS with Ayurvedic formulation and placebo. To be accepted as legitimate medications in the present times, even age-old remedies need to be put through, and prove themselves, in rigorous trials.

Manufacturing of medicines and sale in pharmacy

To ensure quality of Ayurvedic medications, guidelines have been published and strengthened over the years. The concept of Good Manufacturing Practice (GMP) Plants has been adopted for mass production of Ayurvedic medicines over the years. However, several lacunae still persist. The sale of Ayurvedic medicines chiefly as over the counter products and nutraceuticals to avoid regulation must be discouraged strongly and eventually abolished for all but a few medicines. This will also restore dignity of prescription to the Ayurvedic physician.

Efficacy must be proven for the product to be allowed to sell in the market.

At present, Ayurvedic stores do not even have a legal requirement of a pharmacist to dispense the medications, whereas pharmacies selling modern medicine are subject to rigorous checks and must have a qualified pharmacist present at all times. To man the thousands of AYUSH stores across the country, creation of courses that produce qualified pharmacists trained in AYUSH pharmacopeia is the need of the hour. The concept of nutraceuticals too must be shown the door. If a claim of efficacy of a product for certain diseases is made, it is not sufficient to allow the company to take consumers for a ride by providing a disclaimer on the label. Efficacy must be proven for the product to be allowed to sell in the market.

A common misconception among the population at large is that AYUSH medicines have “no side-effects.” This is blatantly untrue, and is compounded by the fact that self-prescription is rampant in this poorly regulated market. There have been numerous case reports of terminal liver failure and irreversible organ damage due to consumption of herbal preparations. Every formulation of AYUSH medicine must carry a pamphlet detailing its ingredients, actions, indications, contraindications, side-effects, adverse effects and other important information as is mandated for modern medicines. Self-medication must be strongly discouraged.

New studies are also needed to identify more herbs and plants with medicinal properties to expand the Ayurvedic pharmacopeia.

Mind-body medicine

The former USP of Ayurveda, simultaneous holistic treatment of mind and body, is also under systematic challenge due to the emergence of various disciplines of psychology and psychotherapy. Popular psychotherapeutic techniques are based on principles similar to those elucidated in the Bhagavad Gita. Yoga has rapidly globalised and is no longer the preserve of traditional Indian disciplines. These challenges have to be addressed head-on by traditional medicine, though admittedly it is not an easy task.

The way forward

In his book, Killing us softly: The sense and nonsense of Alternative Medicine, Dr Paul Offit writes, “There’s no such thing as conventional or alternative or complementary or integrative or holistic medicine. There’s only medicine that works and medicine that doesn’t.” Taking this forward to its logical conclusion, the difference between conventional and alternative medicine too must eventually be removed so that the medicines that work are available to all practitioners. The antagonism between these sciences can only be ended by making them complementary in all respects. For this to be successful, governments must stop treating AYUSH education and practice with kid gloves and subject them to the same stringent norms and requirements expected from practitioners of modern medicine. This author is of the firm view that homeopathy should be decoupled from AYUSH as it lacks any scientific rationale and is not an Indian system of medicine, and its presence as part of the AYUSH pantheon devalues the other legitimate sciences. Also, concepts of various branches of alternative medicine along with treatments can be integrated into modern medicine courses seamlessly to produce doctors who are free to use the medicines that work and discard those which don’t.

The views expressed above belong to the author(s). ORF research and analyses now available on Telegram! Click here to access our curated content — blogs, longforms and interviews.


Amit Thadani

Amit Thadani

Amit Thadani is director at Niramaya Hospital Kharghar Navi Mumbai. He is also visiting consultant at Sushrut Hospital and Apollo Spectra Hospitals Mumbai.

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